High-dose chemotherapy with autologous stem cell transplantation is an effective treatment of primary refractory Hodgkin's disease. Retrospective study of the Polish Lymphoma Research Group

We analysed the treatment outcome of primary refractory HD patients managed with high-dose chemotherapy and haematopoietic cell transplantation. Data of 65 adult patients who underwent HDC/ASCT in nine Polish centres for primary resistant Hodgkin's disease between June 1991 and July 2000 were collected retrospectively. Response rate to HDC/ASC: CR, 54%; PR, 20%; less than PR, 15%; early deaths, 11%. Actuarial 3-year OS and PFS were 55% and 36%, respectively. In multivariate analysis, lack of bulky lymph nodes and use of immunotherapy were favourable factors for both OS and PFS. IPF <3 at the time of transplantation was predictive for PFS. However, the prognostic impact of immunotherapy should be interpreted with caution since this group included more patients who achieved CR after HDC/ASCT. The results of HDC/ASCT are encouraging and confirm earlier findings. The role of immunotherapy should be further investigated in prospective trials.

G-CSF-mobilized leukapheresis products: cellular characteristics and clinical performance in allografting

Twenty-five G-CSF-mobilized leukapheresis products (mLP) were screened for cellular composition, including CD34+DR-, CD34+DR+ and leukocyte profile, to compare with 5 native (unstimulated) LP (nLP) and 16 BM inoculi. G-CSF stimulation led to an increase in CD34+ cells and CD15+ cells but did not influence the lymphocyte content of mLP. Two groups of 14 and 16 patients were allografted with phenotypically defined mLP (1-4 mLP were used for each patient) and BM, respectively. mLP used for allografting had significantly more CD34+ cells, including CD34+DR- cells, monocytes, T cells, and B cells as compared with BM inoculi. Patients were followed for median observation time of 289 days and 409 days for the mLP (PBPC) and BM groups, respectively. The two groups were well matched in regard to age, sex, and stage of disease, with a slight prevalence of major blood group incompatibility (7 of 14 versus 3 of 16) and a lower donor/recipient weight ratio (0.8+/-0.2 vs 1.5+/-0.6, p = 0.002) in the PBPC group. Granulocyte and platelet recovery was faster in the PBPC group than in the BM group. The time of reaching 20,000/microl platelets but not 500/microl granulocytes correlated with the number of CD34+ cells in each inoculum. The survival curves of the PBPC and BM groups were similar, as was the incidence of acute GvHD (aGvHD). This was also valid for aplastic anemia cases (7 and 5 patients in the PBPC and BM group, respectively), who benefited from a high number of CD34+ grafted cells but did not experience aGvHD. Thus, mLP do not appear to elicit aGvHD with higher frequency than BM and may be preferable for hematotherapy.

Hematopoetic progenitor cells transplantation in Poland: structure and clinical practice

The present activity of BM/PBPC transplantations is based on government funded transplantation centers. About 50 alloBMT/PBSC or 1.3 transplant per million per year were performed in the last two years with a tendency to further increase. An increase in the number of autoBMT/PBSC is also seen with about 75 autotransplantations or 2 transplantations per million of people per year. Indications and standard laboratory and clinical practices in Poland are similar to those in other European countries. However, chemotherapy prevails over total body irradiation (TBI) in conditioning regiments. An average long term overall survival of patients with hematological malignancies after alloBMT is higher in paediatric transplantations than in adults (0.56 vs 0.34, p < 0.03) and in patients with a standard risk than in cases with advanced disease (0.48 vs 0.36).

Confirmatory typing results of the National Polish Bone Marrow Donors Registry

Preliminary analysis of HLA class I typing of 618 individuals (patients and healthy members of 153 families) referred to the National Polish Bone Marrow Donors Registry (NPBMDR) for a donor search revealed that the number of undetected locus A and B antigens was more frequent than it was reported in a large scale population study in Poland (0.28 vs 0.076, p=0.000). This was associated with a lack of typing of family members for 51 out of 153 patients. 171 individuals primary typed (140 by serology and 31 by DNA typing) in 6 different Polish institutions were retyped in our laboratory with the use of PCR-SSO or PCR-SSP techniques. The results were discrepant in 50 cases (29%) including 19 patients and 31 family members. In 46% one DR specificity was missing, false typing of one or two specificities was evident in 46% and 14% of erroneous typing, respectively. The highest rate of errors was found in DRw52 group of specificities with the most difficult DR13 (32% of all false typing and 67% of errors within DRw52 group).

Adjuvant spleen ultrafiltrate immunotherapy in unresectable advanced non small cell lung cancer

The purpose of this study was to assess the possible benefit of adjuvant spleen ultrafiltrate immunotherapy in advanced lung cancer patients on chemotherapy. Twenty-six patients with inoperable non-small cell lung carcinoma were eligible to this study and randomised divided into two groups. The two groups received additionally to standard chemotherapy--three times once a month--placebo or spleen ultrafiltrate (Prosplen), respectively, given to the patients for 14 days beginning from the 7th day after each chemotherapy. To evaluate the effects of spleen ultrafiltrate, the time of haematological recovery and profile of peripheral blood lymphocytes and clinically number of days with fever and oncological response were documented. During the observation time patients receiving spleen ultrafiltrate had a higher number of leukocytes (p = 0.01) and higher counts (p = 0.03) and percentage of granulocytes (p < 0.001) including nadir values (p = 0.05) in blood. The positive effect was also seen in natural killer cells (p = 0.005) but not in T cells compartment. This could be of clinical significance because patients receiving spleen ultrafiltrate presented less frequently febrile episodes than patients in the placebo group (75 vs. 127 days with body temperature > 38 degrees C, p = 0.007) and had less frequently highly elevated serum C-reactive-protein levels (p = 0.02). Notably, 2 out of 12 patients receiving in addition to chemotherapy spleen ultrafiltrate and 7 out of 14 lacking this adjuvant treatment showed tumor progression during the treatment. Serum C3 levels were associated with progression of disease in both groups (p = 0.03). Overall, spleen ultrafiltrate receiving patients had lower serum C3 values than placebo receiving patients. Serum IgM levels were rather high in the placebo group (p = 0.033). Spleen ultrafiltrate is thought to benefit patients on palliative chemotherapy in advanced metastatic cancers.